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No Benefit of High-Dose Epinephrine in Child CPR

A standard dose of 0.01 mg/kg remains the one to use.

The use of epinephrine in cardiopulmonary resuscitation is intended to improve coronary and cerebral perfusion. Some experts contend that a standard dose (0.01 mg/kg) achieves this goal less well than higher doses, but recent evidence to support this contention is slim. The recommended initial dose in child CPR is the standard dose, but there is debate about whether subsequent doses (if needed) should be increased to 0.1 mg/kg.

In a randomized trial, researchers enrolled 68 children (mean age, 6 years) who remained in cardiac arrest after initial in-hospital CPR with standard-dose epinephrine. For subsequent doses, children received either the standard dose or the higher dose (0.1 mg/kg). Informed consent was waived.

At 24 hours, only one child in the high-dose group and seven children in the low-dose group were alive (odds ratio for death, 8.6; 95% CI, 1.0-397.0). No high-dose recipients and four standard-dose recipients survived to discharge. Of the four survivors, two were alive and neurologically normal at 6 months.

Comment: For children who remained in cardiac arrest after initial in-hospital CPR, a higher rescue dose of epinephrine had no advantage over a standard dose and might have been harmful. Nevertheless, prognosis was grim with either regimen. The editorialists believe that, for now, these results are sufficient to support use of the standard dose for rescue in children.

— Harlan M. Krumholz, MD, SM

Published in Journal Watch Cardiology June 11, 2004

Citation(s):

Perondi MBM et al. A comparison of high-dose and standard-dose epinephrine in children with cardiac arrest. N Engl J Med 2004 Apr 22; 350:1722-30.

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• Medline abstract (Free)

Lister G and Pérez Fontán JJ. Can resuscitation jeopardize survival? N Engl J Med 2004 Apr 22; 350:1708-9.

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• Medline abstract (Free)